Four Tips for Preventing Little League Elbow

Medial epicondyle apophysitis -- better known by its street name "little league elbow" -- is an inflammation of the inner elbow that affects an alarming number of youth baseball players across America. Pitchers are most affected by this injury, which is the result of the excessive stress on the growth plate in a child’s forearm caused by excessive throwing. Children who experience little league elbow often complain of pain on the inside of their elbows and an inability to fully extend their arms.

Posted on | Luke Bongiorno, PT | Comments ()

Medial epicondyle apophysitis -- better known by its street name "little league elbow" -- is an inflammation of the inner elbow that affects an alarming number of youth baseball players across America. Pitchers are most affected by this injury, which is the result of the excessive stress on the growth plate in a child’s forearm caused by excessive throwing. Children who experience little league elbow often complain of pain on the inside of their elbows and an inability to fully extend their arms.

If your child plays organized baseball, there are steps you can take to prevent little league elbow before it starts. 

1. Monitor your child's pitch counts.
Many little leagues across the country now have strict rules regarding the number of pitches their young players can throw in a game. However, those safeguards may not be in place for your child's league. Especially for those kids who play in multiple leagues, pitch limits must be carefully monitored to prevent overuse damage. Talk with your child's baseball coach and let him or her know your concerns. Children ages 9-10 should throw no more than 50 pitches per game, or 75 in a week. Meanwhile, 11- and 12-year-olds should be kept to 75 pitches per game and 100 per week. And kids between 13 and 15 should keep their counts under 75 per game and 125 per week.​

2. Monitor the frequency of your child's pitching.
The number of times your child pitches during the week is also important. Even in the major leagues, starting pitchers throw only once every four days. Your child needs a break, too, and his rest time should depend on the number of pitches he threw in his last game. For pitchers ages 7-16, pitch counts can be easily broken up into units of 20. For example, 20 pitches or fewer require one day of rest; 20-40 require two days off; 40-60 require three days of rest; and anything above 60 pitches requires a break of at least four days.​

3. Monitor the type of pitches your child is throwing.
"Breaking" pitches are harmful to a child’s developing body and should be avoided. Children's bones have not completely matured, and the mechanics needed to execute breaking pitches place undue stress on key developmental joints in the elbow and shoulder. The USA Baseball Medical & Safety Advisory Committee recommends that only players 14 years and older should be allowed to throw breaking pitches, which include curveballs, sliders, knuckleballs and screwballs.​

4. Monitor your child's preparation.
Don’t let your child pitch if he hasn't stretched or warmed up. Stretching loosens muscles and helps prevent injury. Warming up will not only help your child get focused for the game, but it can help him safely stretch the specific muscles he'll need to play the game. Stretching when the game is over can be another great way for your child to make sure that his muscles don't become too tight following all that physical activity.​

Little league elbow can be a painful, serious injury for your growing child. In extreme cases, the growth plate can detach from the arm and require surgery to repair. Follow the four tips above and your child will be on the road to enjoying pain-free baseball for years to come.

Blog written by Luke Bongiorno, PT
Luke Bongiorno is one of New York’s highest regarded physical therapists. He is an owner and the managing director at NY Sports...